Permit ih CITY OF TIGARD PLUMBING PERMIT
:. COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00354
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/27/2008
PARCEL: 2S115AD -00600
SITE ADDRESS: 16740 SW 108TH AVE ZONING: R -4.5
SUBDIVISION: WILLOW BROOK FARM LOT: 030 JURISDICTION: TIG
PROJECT: HACKET
Project Description: Installing combo washer / dryer unit under kitchen counter.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
BRUCE HACKET
16740 SW 108TH AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 8/27/2008 $72.50
[TAX] 12% State Surch 8/27/2008 $8.70
Phone : 509- 995 -9392 Total $81.20
Contractor:
3 MOUNTAINS PLUMBING
20345 SW PACIFIC HWY STE 103
SHERWOOD, OR 97140 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 925 -1342
FAX 503- 925 -9104
Reg #: LIC 169499
PLM PB99
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
or
Issued B �'/ Permittee Signature: 5..€.. y-i7/ GG /j
•
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
08 - 26 -2008 15:08 3 MTNS PLUMBING 5039259104 PAGE2
. 0
\
Plumbing Permit Application ",, l
' - TOR Ohl 1( 1.•S1 0■1.1 •
City of Tigard Received -`�
I31M5 SW }{all Blvd.. Tigard. OR 97223 a� \ \ \ % °, • DatrBv: 1� y P c m „t N , (JL r , -� , IJ
Phone: 503.639.4171 Fax; 503.598.1960 C k� � Plan RecieH Other Permit No
P� 14 -, 7I i ' OApace Re
�
24- Hour Inspection Line: 503.639 J175 Crate. Read : RI See Page 1 for
P J �! 1 � )uris:
Internet: www.ci.tigard.or. +,s ' . - Notified :Method: 77 Supplemental Information
TIDE Ow \'Ulth l Mtit * ti(:Hf:l)1 1t_
N ew constr
❑ ' ~ construction ❑ Alp non For eeimin nrmwinrr u s e cl�eck(i
,� - Description Om La. Total
Lrl Addition /aiteruiiot, /replACemcnt ❑Other: - � ties I - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF C :ONSTRI!CTIOM1' SFR (1) bath 249.20
l - and 2-family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
0 Accegsory building ❑ Multi-family SFR (3) bath 349,00
._ Each additional bat /kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB STI'E INFORMATION AND LOCATION Site utilities
Job site address: / 7 i O $01 /0 7' r�►'Pe Catch basin or area drain i 6.6(1
City /State /ZIP; / / ' ,�, .-- c OA / � f 2 y - Dr) „ell, leach line. or trench drain 16,60
1
SuiirPo)dg. /api, no.: 1 Project name: / e ,L cr,(GJ Footing drain (nu, linear R,; ._) Page 2
Manufactured home utilities 1 10.00
Cross street/directions 10 job site: m.,. Manholes 16.60 _
—
fee. ,4, ,__,�4e .. Rain d RaTn-d . .
rain connector 16.f 0
/0 6 _ - Sanitary sewer mu. linear fl.: ) Page 2
Storm sewer (no. linear ft.: ) _ Page 2
Subdivision; _ Lot no,: Water yen ice (no. linear ft.: �) age 2
Fax map /parcel no. Fixture or item —y
Absorption valve 16,60
DESCRIPTION OF WORN Back flow preventer Page 2
�.. _ 1: ca � (! 16.60
Backwater valve -
/' _ _ .., -
4P O j r � � r .. (314. — Clothes washer ,. , / 6 6
� 16.60 ,
/�ft Dishwasher 16,60
I'IIOPERTI' OWNER Drinking fountain 16.(10
❑ TENANT — .
_
l-jcctors /sump 16.60
Name: eC 1 4C� /74d -G/�
Expansion tank 16.60
Address: Fixture/sewer cap_ 16.60
City /State /ZIP: Floor drein/flnor sink/hub 16,60
Phone: ($0 f - f 9.r.: 3 t r� Fax: ( ) Garbage disposal 16.60
❑ APPLICANT CONTACT PERSON I lose hit, 16.6
Pi
.. - -. /� _, � !cc make, 1 6.60 �—
Business name; r {—e rr[ OGGst Alie s - / -rs'l ,( - ._ .
G r ��/ lntcrceptor / g r ease trap
1°1 16.60
Contact name: r - - Medical
PIP gas (value; $ ) Page 2
Address: 5 •
'. GC f � � 1 G4- y'/1�0 Primer
— 16.60
City /State /ZIP; ./ d `r _ rl 2 - 7 y / / ii, Roof drain (commercial) 16 60 _
Phone: ( 5V) 4 Z7.--r— /1 er F ax:: ( ) Sink/bain/lavatory / 16.60 f �
' ?z S' 7r J - Tub /shower /shower pan 1660)
E- m .►)!
ail; e' r •* • O cr.�[ 3 5; 4 tr/ 7 • Co 0.'7 Urinal -
�J 1 _ 660
CONTRLA('TOR _ Water closet 16.60 -- —
Business name: 544n-48°- Water heater 16.60
Address: Other;
City /State/ZIP: — Subtotal 3 ,,Li)
' - Minimum permit fee: 572.50 w
Phone: ( ) Fax: ( ) Residential bac}dlow minimum permit fce: 536.25 V' • SO
CCR Lic,: / 9. y r7 „ Pltunbin I .ic, no.: Plan review (25% of permit fee) gi�c
/ State surcharge (8% of permit fee)
Authorized signature: __
l'OTA1. PERMIT FEE 2.0
Print name: trhrt4 r" t -0 r a. in Date: Bly►4, /0 This permit application expires if a permit is not obtained within
f 180 days alter it has been accepted as eowpletc.
'`Fee methodology set by Tri- County Building industry Service Board.
- . .
CITY OFTAGARD
BUILDING DIVISION
PERMIT #:
PLM2008
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 812712008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 —WO- I.L.
INSPECTION WORKSHEET FOR DATE: TIME: 7:00AM PAGE:
10/13/2008 35
SITE ADDRESS: 16740 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
WILLOW BROOK FARM 030
PROJECT NAME:
HACKET
DESCRIPTION:
Installing combo washer / dryer unit under kitchen counter.
OWNER: PHONE #:
FIACKE1 , BRUCE 509.995
CONTRACTOR: PHONE # 503
3 MOUNTAINS PLUMBING
Inspection Request Scheduled For: Date: 1W13/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 07657401 503-9251342 N
Corrections/Comments/Instructions:
C'a Pe- 'C L-c-X- 1,J
A PASS 0 PARTIAL APPROVAL n CANCEL 0 NO ACCESS
FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: ITS\11■ \IIN-A*-- Date: ) o f i I D Phone #: (503) 718-
, .
CITY OF TIGARD
BUILDING DIVISION . ,
. - . - PERMIT #: PLM2008- 00354
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/27/2008
Phone: (503) 639 -4171 ao p I � •
Inspection Requests (24 Hrs.): (503) 639- 4175 L.
INSPECTION WORKSHEET FOR DATE: 9/3/2008 TIME: 7:01AM PAGE: 16
SITE ADDRESS: 16740 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: WILLOW BROOK FARM LOT #: 030 TYPE OF USE:
PROJECT NAME: HACKET
DESCRIPTION: Installing combo washer / dryer unit under kitchen counter,
OWNER: HACKET, BRUCE PHONE #: 505 -995 -9392
CONTRACTOR: 3 MOUNTAINS PLUMBING PHONE #: 501925 -1342
Inspection Request Scheduled For: Date: 9/3/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 075001 -01 503 - 925 N
Corrections /Comments /Instructions:
y l PASS n PARTIAL APPROVAL ❑ CANCEL NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Vv4wi \ L Date: el I (2 ± Phone #: (503) 718-